Pisa Syndrome in Parkinson’s Disease: A Novel Rehabilitation Approach in a Microgravitary Environment

Background: Pisa Syndrome (PS) is clinically defined as the sustained lateral bending of the trunk and worsened by prolonged sitting or walking. Aim of the study: To measure the effect of postural exercises under microgravity conditions using the Dynamic-Antigravity-Postural-System (SPAD) and focal mechanical vibration (ViSS) in PS patients. Materials and methods: A proof concept study was performed. Twenty (N=20) (mean age 68 ± 8,4 years) consecutive patients affected by Pisa Syndrome in Parkinson’s Disease with trunk lateral flexion were included. Patients were divided into two groups of 10 patients according to electromyography characteristics: neurogenic group (hyperactivity of lumbar paraspinals ipsilateral to the trunk leaning side) and myogenic group (hyperactivity of paraspinals contralateral to the trunk leaning side). Results: We found improvements especially in myogenic group, in terms of decrease of lateral trunk flexion (61%, compared to 35% of the neurogenic group) and in terms of improvement in paraspinal EMG measurement (43% compared to 14% of the neurogenic group) after rehabilitation treatment (T1) respect baseline (T0). Conclusion: This study suggested the efficacy of specific postural training in a microgravitary environment with SPAD system in combination with focal mechanical vibration as an integrative rehabilitation program in Pisa Syndrome patients.